Occupational Therapy and Physical Therapy

Insurance Coverage for Therapy Services

Know What Your Insurance Covers

Many insurance plans cover occupational therapy and physical therapy services, but there may be certain conditions that apply.

It's important to know what your plan will cover before your child begins therapy.

Call your insurance company to find out what services your plan covers. Here are some questions you should ask:

Does my plan provide coverage for the type of therapy my child needs?
What do I need to do to obtain authorization for therapy services?
How many therapy sessions are allowed under my insurance plan?
How can I make sure all the necessary referrals are in place?

If you have secondary health insurance (if another person in your household also has insurance), be sure to check with that insurance company about coverage, too.

It is your responsibility to understand your coverage and to obtain authorization for services. If you need help in doing this, our OT/PT Financial Service Representative will make every effort to contact your insurance company to help determine eligibility for therapy services.

The OT/PT Financial Service Representative

If you need assistance with your insurance coverage, our OT/PT Financial Service Representative can help you in the following ways:

We will contact your insurance company to verify your eligibility for therapy benefits. It is important to note that the insurance company will state that a quote of benefits does not guarantee coverage and that payment is subject to further approval.
We will determine if prior authorization or pre-certification is needed for services. If it is required, we will follow the steps necessary to obtain authorization for therapy services.
We will assist you with any other insurance questions you might have.
We will provide guidance regarding additional financial resources that might be available to you.

Your Role as Parent/Legal Guardian

You are responsible for payment of therapy services if your insurance plan denies coverage. Insurance companies can deny payment for services even after they have authorized visits if they do not think the services are medically necessary. The decision to pay for services is made by the insurance company when the claim is received, and is based upon the insured person's eligibility on the date of service

If you are unsure about whether your child's therapy is covered, wait to schedule to the appointments. Although you may schedule your child's therapy prior to obtaining insurance authorization, you are responsible for payment if the sessions are not authorized.

If Therapy Coverage is Denied

You can make an appeal to your insurance company for reconsideration. Contact your insurance company's Member Services department for an explanation of how to make an appeal.

You can also ask your child's therapist to assist you by writing a "Letter of Medical Necessity" to the insurance company.

Contact an OT/PT Financial Service Representative to assist you in obtaining your child's therapy notes to forward to the insurance company and to help you with any questions.

Paying for Therapy Out-of-Pocket

You can continue therapy and pay out-of-pocket for the services. Our department offers a special pre-payment program that provides a discount for services when a non-refundable payment is made in full before the first treatment session. We offer package plans for 4, 8, 10 and 20 sessions (Each session is 1 hour). Contact a Financial Service Representative for an application or if you have questions.

Discuss how to reduce costs for therapy with your child's therapist. Some option include scheduling sessions less frequently and increasing home exercise/activity programs, using community-based programs, and others.

Explore financial assistance options. Contact an OT/PT Financial Service Representative to assist you with identifying options such as Medicaid Disability, Bureau for Children with Medical Handicaps-BCMH (Ohio Bureau for Children with Medical Handicaps) or ARC Hamilton County